A Qualitative Study on the Perspectives of Latinas Enrolled in a Diabetes Prevention Program: Is the Cost of Prevention Too High?
A Qualitative Study on the Perspectives of Latinas Enrolled in a Diabetes Prevention Program: Is the Cost of Prevention Too High?
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DOI：
10.1177/2150132720945423
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发表时间：
2020-01
影响因子：
3.6
通讯作者：
Montgomery SB
中科院分区：
文献类型：
--
作者：
Joachim-Célestin M;Gamboa-Maldonado T;Dos Santos H;Montgomery SB
简介：拉丁美洲人是受糖尿病健康差异影响最大的群体之一，但他们往往从糖尿病干预措施中获益较少，即使这些干预措施在文化上是适应的。本定性研究的目的是探讨准备参加糖尿病预防计划的拉丁美洲人采取建议的预防行为，并确定与采用和维持这些建议的生活方式改变相关的因素。所获得的见解将用于为未来减少拉丁美洲人糖尿病差异和慢性病负担的努力提供信息。研究方法：九个焦点小组讨论（FGD）和3个关键的线人访谈（KII）完成后，由拉丁裔社区卫生工作者领导的文化适应性糖尿病预防计划。Charmaz的扎根理论方法由跨理论模型指导问题。讨论和访谈在参与者的许可下进行录音，转录，编码和主题。结果：40个低收入的拉丁美洲人贡献了FGD和KII。参与新行为的基线准备程度各不相同。消极的个人和家庭健康事件和医生转诊影响了大多数人的入学准备和采取预防行为。建筑环境、经济限制和社会疏离的威胁构成了行为采纳和维持的主要障碍，而医生的参与、对糖尿病并发症的认识和社会支持部分缓解了这些障碍。结论：我们的研究结果表明，在为低收入拉丁裔规划糖尿病预防计划时，应考虑入组时间、医患动态以及行为改变的个人/家庭情感成本。除了适当的时间转介到可访问的文化知情的预防计划，健康教育工作者和卫生保健提供者应该意识到的潜在负面影响的行为修改对家庭动态，并准备解决由此产生的影响。未来对拉丁裔的研究还应包括和报告有关医生参与，家庭背景和健康的社会决定因素的数据，以进行更一致的计划比较。
Introduction: Latinas are among the groups most affected by diabetes health disparities, yet they often benefit less from diabetes interventions even when these are culturally adapted. The purpose of this qualitative study was to explore readiness of Latinas enrolled in a diabetes prevention program to adopt recommended preventive behaviors, and to identify factors associated with the adoption and maintenance of these recommended lifestyle changes. Insights gained will be used to inform future efforts at reducing diabetes disparities and the burden of chronic diseases among Latinas. Methods: Nine focus group discussions (FGDs) and 3 key informant interviews (KIIs) were conducted after the completion of a culturally adapted diabetes prevention program led by Latino community health workers. A grounded theory approach by Charmaz informed by the transtheoretical model guided the questions. Discussions and interviews were audio-taped with participants’ permission, transcribed, coded, and themed. Results: Forty low-income Latinas contributed to FGDs and KIIs. Baseline readiness to engage in new behaviors varied. Negative personal and family health events and physician referral impacted most readiness to enroll and to adopt preventive behaviors. Built environment, financial constraints, and threat of social alienation constituted major barriers to behavior adoption and maintenance, while physician involvement, awareness of diabetes complications, and social support partially mitigated these impediments. Conclusions: Our results suggest that timing of enrollment, physician-patient dynamics, and the emotional personal/family cost of behavior modification should all be considered when planning diabetes prevention programs for low-income Latinas. Besides appropriately timing referrals to accessible culturally informed prevention programs, health educators and health care providers should be aware of the potentially negative impact of behavior modification on family dynamics and be prepared to address resulting repercussions. Future research on Latinas should also include and report data on physician involvement, family context, and social determinants of health for more consistent program comparisons.